Hand Hygiene
1. In a nonoutbreak setting, there is no consensus on the optimal
approach to hand hygiene when caring for a patient with CDI.
Based on a hospital's assessment of risk, any of the following
options could be considered:
• Standard hand hygiene using alcohol-based hand rub (ABHR) for room
entry and exit.
• Soap and water hand hygiene for room exit only, with ABHR for room
entry and when needed between tasks for a single patient unless hands are
visibly soiled.
• Soap and water preferred over ABHR for room entry and exit.
2. Soap and water are recommended for hand hygiene during a
C. difficile outbreak or in hyperendemic settings.
3. The facility must consider sink accessibility when making
recommendations for soap-and-water hand hygiene.
Isolation
➤ Infants with diarrhea and a positive C. difficile test should be
placed on contact precautions. Infants without diarrhea who have
tested positive for C. difficile do not require contact precautions.
➤ Contact precautions can be discontinued 48 hours after diarrhea
has resolved. At that time, consideration can be given to moving
the patient to a new incubator and/or a new room.
1. Determining true CDI rates in the NICU is difficult because testing is not
recommended and positive results most likely reflect colonization.
2. Prolonging contact precautions until discharge could result in extended
isolation for premature infants who are expected to remain hospitalized for
long durations. Although emerging data suggest that asymptomatic carriers
may also play a role in transmission, current guidelines do not recommend
using contact precautions for colonized patients without diarrhea.
Prevention
